Independent Medical Opinion – Nexus Letters

What is a Nexus Letter?

A nexus letter, also known as an Independent Medical Opinion (IMO), is a formal document in the VA disability claims process, written by a qualified medical professional. It provides an expert medical opinion establishing a “nexus,” or connection, between a veteran’s current medical condition and their military service, addressing how events or exposures during service relate to the condition. 

This letter can be crucial for substantiating service-connected disability claims, especially when the cause is not evident in standard military records or when conditions have worsened post-service. For example, a veteran’s hearing loss worsens after military service due to prolonged noise exposure from aircraft. 

A well-supported nexus letter can significantly strengthen a veteran’s claim and increase their chances of securing an accurate VA disability rating by providing strong evidence of the service connection.

How can you benefit from a Nexus Letter?

In some circumstances, a nexus letter is important for obtaining VA disability benefits, especially when direct evidence of a service-related condition is absent. By bridging gaps in documentation, it helps the VA understand how military service contributed to or aggravated a veteran’s condition. 

Nexus letters provide an expert, independent medical opinion that affirms the link between a veteran’s disability and military service, establishing that it is “at least as likely as not” that the condition is service-connected. Nexus letters may enhance the success rate of a VA claim or increase your VA disability rating. Often provided by an experienced healthcare professional, a nexus letter can be decisive in appeals or cases with initial claim denials. 

It is always best to seek expert legal consultation with an accredited VA legal representative when considering whether this may be a good option for your military service connection claim.

How do you get a Nexus Letter?

If you need a Nexus Letter, our team of experienced, licensed medical professionals would be happy to review your case. You may also find VA Nexus Letter doctors near you by simply asking your primary care doctor or a specialist familiar with your condition to assist with reviewing your medical history and service records. 

Each of our independent medical examiners (IME) specializes in VA nexus letters and understands the letter must meet all requirements to assist veterans seeking to obtain a successful disability claim. 

After reviewing the relevant files, if the medical opinion is supported, our experts compose a detailed Nexus Letter, explicitly linking your service-related disabilities to your current medical condition that may aid in securing the VA benefits you’ve earned. Once obtained, your doctor’s letter, medical records, and supporting evidence, can be submitted by you or your accredited legal professional by filling out VA Form 21-4138 to inform the VA that you’ve submitted a disability compensation claim.

Which Claims Require a Nexus Letter? 

Nexus letters are never required but can be helpful for VA disability claims that are not automatically presumed to be service-connected. For conditions not on the VA Presumptive List such as certain types of arthritis, sleep apnea, mental health disorders, and chronic pain issues, a nexus letter can provide the necessary link to military service. 

Veterans claiming secondary conditions, which result from or are worsened by an already service-connected condition, also benefit from a nexus letter to validate these links. For instance, if a veteran’s service-connected back injury leads to hip pain, a nexus letter from an orthopedic specialist connecting these issues can greatly strengthen the claim.

4 Elements of a Strong Nexus Letter

A compelling nexus letter includes four essential elements: the physician’s credentials, a review of VA medical records, a professional opinion, and a supporting rationale. 

1. Physician’s Credentials: First, the physician’s qualifications establish their expertise in the relevant medical field. Oftentimes Nurse Practitioners and Physician Assistants compose these reports as well. 
2. Reference: Next, the letter should show that the physician has reviewed all pertinent service and post-service medical records, which adds credibility. 
3. Medical Opinion: The professional nexus opinion must clearly state that it is “at least as likely as not”or “more likely than not” that the current disability is service-related. 
4. Medical Rationale: Lastly, the rationale should cite relevant medical studies or established knowledge to reinforce the opinion, making the case stronger and more convincing for the VA.

How to Increase the Success Rate of a Nexus Letter?

Following these steps can significantly strengthen the impact of your nexus letter and improve your chances of a successful VA claim.

• Work with an Experienced VA Claims Doctor – Choose a physician familiar with VA disability claims who can establish the connection between your current disability and military service. Ideally, this physician should have recently examined you. Other medical practitioners like Nurse Practitioners, Physician Assistants, and in some case Audiologists, Optometrists and Psychologists can be helpful as well. 
• Use VA-Preferred Language – Ensure the letter includes phrases like “at least as likely as not” to meet VA evidentiary standards.
• Review Full Medical Records – The doctor or other health care provider should confirm they’ve reviewed all relevant service and post-service medical records for a comprehensive assessment of your medical history. 
• Cite Supporting Medical Research or Case Law – Include references to research or case law that supports the link between your current diagnosis and military service. 
• Keep the Letter Concise – A clear, brief but well-documented letter often carries more weight in the VA’s decision-making process.

Cost of a Nexus Letter

The cost of a nexus letter varies depending on the provider and the complexity of the case. Generally, these letters range from $500 to $2000 or more, especially when a specialist’s assessment is needed. 

Costs may also increase if extensive record reviews or additional testing are required. Though this can be a significant investment, a well-written VA nexus letter can prove invaluable, potentially leading to benefits worth thousands monthly. Some independent medical opinion providers may offer payment plans, making this expense more manageable for veterans. You may also obtain a letter for little to no cost from your treating provider or the VA. 

Ultimately, the cost of a nexus letter often reflects the expertise and thoroughness necessary for those seeking to present a strong VA disability claim.

Do You Need a Nexus Letter for Secondary Conditions?

While never required, a nexus letter can be crucial for secondary conditions—those caused or worsened by an existing service-connected disability. For instance, if service-connected PTSD led to hypertension over time, a nexus letter can explain this relationship. In these cases, the letter must detail how the secondary condition is medically linked to the primary service-connected condition and has caused or aggravated the condition, reinforcing the VA claim. 

By establishing this cause-effect relationship, a successful nexus letter can substantially boost the likelihood of receiving VA benefits for a secondary claim, underscoring the full impact of the veteran’s service on their health.